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From the 9/17/2021 release of VAERS data:

This is VAERS ID 611802



Case Details

VAERS ID: 611802 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2015-08-07
Onset:2015-08-07
   Days after vaccination:0
Submitted: 2015-11-11
   Days after onset:96
Entered: 2015-11-25
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH J28923 / UNK LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Chills, Erythema, Headache, Joint swelling, Myalgia, Pain in extremity, Pyrexia, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/07/2015, Body temperature, 101 Fahrenheit
CDC Split Type: 2015270135

Write-up: This is a spontaneous report obtained from a contactable physician through a Pfizer sales representative. A female patient of an unspecified age (from 16 to 18 years old) received on 07Aug2015 TRUMENBA (lot number J28923, expiry date Jun2016) at 0.5 ml single, intramuscular, in left upper arm. No antipyretic was given prior to vaccine. No other vaccines were given on the same day or within four weeks prior to date of vaccination. Relevant medical history and concomitant medications were unknown. On 07Aug2015, the patient experienced swelling (swelling of arm pain), redness, pain, muscle aches, feeling hot touch, fever at 101 degrees F, chills and headache. Clinical outcome of the events was unknown. The events did not require an emergency room of physician visit. The reporter considered there was a reasonable possibility that the events were related to the suspect vaccine. Follow-up (25Sep2015): New information from the same contactable physician includes: vaccine lot number, expiry date, route of administration, posology, additional events ''chills'' and ''headache'', causality assessment.


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